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Trudeau ME, Chapman JAW, Guo B, Clemons MJ, Dent RA, Jong RA, Kahn HJ, Pritchard KI, Han L, O'Brien P, Shepherd LE, Parissenti AM. A phase I/II trial of epirubicin and docetaxel in locally advanced breast cancer (LABC) on 2-weekly or 3-weekly schedules: NCIC CTG MA.22. SPRINGERPLUS 2015; 4:631. [PMID: 26543765 PMCID: PMC4627986 DOI: 10.1186/s40064-015-1392-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/01/2015] [Indexed: 01/23/2023]
Abstract
This phase I/II neoadjuvant trial (ClinicalTrials.gov identifier NCT00066443) determined maximally-tolerated doses (MTD), dose-limiting toxicities, response-to-therapy, and explored the role of novel response biomarkers. MA.22 accrued T3N0, any N2 or N3, and T4 breast cancer patients. Treatment was 6 cycles of 3-weekly (Schedule A; N = 47) or 8 cycles of 2-weekly (Schedule B; N = 46) epirubicin/docetaxel chemotherapy in sequential phase I/II studies, with growth factor support. In phase I of each schedule, MTDs were based on DLT. In phase II, clinical responses (CR/PR) and pathologic complete responses (pCR) were assessed. Tumor biopsy cores were obtained pre-, mid-, and post-treatment: 3 for pathologic assessment; 3 for microarray studies. DLT for Schedule A was febrile neutropenia at 105 mg/m2 epirubicin and 75 mg/m2 docetaxel; for schedule B, it was fatigue at 75 mg/m2 for both agents. Phase II doses were 90 mg/m2 epirubicin/75 mg/m2 docetaxel for Schedule A and 60 mg/m2 (both agents) for Schedule B. Schedule A CR/PR and pCR rates were 90 and 10 %, with large reductions in tumor RNA content and integrity following treatment; Schedule B results were 93 and 0 %, with smaller reductions in RNA quality. Pre-treatment expression of several genes was associated with clinical response, including those within a likely amplicon at 17q12 (ERBB2, TCAP, GSDMB, and PNMT). The combination regimens had acceptable toxicity, good clinical response, induction of changes in tumor RNA content and integrity. Pre-treatment expression of particular genes was associated with clinical responses, including several near 17q12, which with ERBB2, may better identify chemoresponsiveness.
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Affiliation(s)
- Maureen Elizabeth Trudeau
- Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Judith-Anne W Chapman
- NCIC Clinical Trials Group, Queen's University, 10 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Baoqing Guo
- Advanced Medical Research Institute of Canada (AMRIC), 41 Ramsey Lake Road, Sudbury, ON P3E 5J1 Canada
| | - Mark J Clemons
- The Ottawa Hospital Cancer Centre, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Rebecca A Dent
- Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Roberta A Jong
- Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Harriette J Kahn
- Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kathleen I Pritchard
- Sunnybrook Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Lei Han
- NCIC Clinical Trials Group, Queen's University, 10 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Patti O'Brien
- NCIC Clinical Trials Group, Queen's University, 10 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Lois E Shepherd
- NCIC Clinical Trials Group, Queen's University, 10 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Amadeo M Parissenti
- Advanced Medical Research Institute of Canada (AMRIC), 41 Ramsey Lake Road, Sudbury, ON P3E 5J1 Canada
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Early prediction of response to neoadjuvant chemotherapy in breast cancer patients: comparison of single-voxel 1H-magnetic resonance spectroscopy and 18F-fluorodeoxyglucose positron emission tomography. Eur Radiol 2015; 26:2279-90. [DOI: 10.1007/s00330-015-4014-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/30/2015] [Accepted: 09/04/2015] [Indexed: 12/20/2022]
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Kostakoglu L, Duan F, Idowu MO, Jolles PR, Bear HD, Muzi M, Cormack J, Muzi JP, Pryma DA, Specht JM, Hovanessian-Larsen L, Miliziano J, Mallett S, Shields AF, Mankoff DA. A Phase II Study of 3'-Deoxy-3'-18F-Fluorothymidine PET in the Assessment of Early Response of Breast Cancer to Neoadjuvant Chemotherapy: Results from ACRIN 6688. J Nucl Med 2015; 56:1681-9. [PMID: 26359256 DOI: 10.2967/jnumed.115.160663] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/18/2015] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED Our objective was to determine whether early change in standardized uptake values (SUVs) of 3'deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) using PET with CT could predict pathologic complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NAC). The key secondary objective was to correlate SUV with the proliferation marker Ki-67 at baseline and after NAC. METHODS This prospective, multicenter phase II study did not specify the therapeutic regimen, thus, NAC varied among centers. All evaluable patients underwent (18)F-FLT PET/CT at baseline (FLT1) and after 1 cycle of NAC (FLT2); 43 patients were imaged at FLT1, FLT2, and after NAC completion (FLT3). The percentage change in maximum SUV (%ΔSUVmax) between FLT1 and FLT2 and FLT3 was calculated for the primary tumors. The predictive value of ΔSUVmax for pCR was determined using receiver-operating-characteristic curve analysis. The correlation between SUVmax and Ki-67 was also assessed. RESULTS Fifty-one of 90 recruited patients (median age, 54 y; stage IIA-IIIC) met the eligibility criteria for the primary objective analysis, with an additional 22 patients totaling 73 patients for secondary analyses. A pCR in the primary breast cancer was achieved in 9 of 51 patients. NAC resulted in a significant reduction in %SUVmax (mean Δ, 39%; 95% confidence interval, 31-46). There was a marginal difference in %ΔSUVmax_FLT1-FLT2 between pCR and no-pCR patient groups (Wilcoxon 1-sided P = 0.050). The area under the curve for ΔSUVmax in the prediction of pCR was 0.68 (90% confidence interval, 0.50-0.83; Delong 1-sided P = 0.05), with slightly better predictive value for percentage mean SUV (P = 0.02) and similar prediction for peak SUV (P = 0.04). There was a weak correlation with pretherapy SUVmax and Ki-67 (r = 0.29, P = 0.04), but the correlation between SUVmax and Ki-67 after completion of NAC was stronger (r = 0.68, P < 0.0001). CONCLUSION (18)F-FLT PET imaging of breast cancer after 1 cycle of NAC weakly predicted pCR in the setting of variable NAC regimens. Posttherapy (18)F-FLT uptake correlated with Ki-67 on surgical specimens. These results suggest some efficacy of (18)F-FLT as an indicator of early therapeutic response of breast cancer to NAC and support future multicenter studies to test (18)F-FLT PET in a more uniformly treated patient population.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Paul R Jolles
- Virginia Commonwealth University, Richmond, Virginia
| | - Harry D Bear
- Virginia Commonwealth University, Richmond, Virginia Massey Cancer Center of Virginia Commonwealth University, Richmond, Virginia
| | - Mark Muzi
- University of Washington, Seattle, Washington
| | - Jean Cormack
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - John P Muzi
- University of Washington, Seattle, Washington
| | - Daniel A Pryma
- Abramson Cancer Center and Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Sharon Mallett
- American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania; and
| | - Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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Chaudry M, Lei X, Gonzalez-Angulo AM, Mittendorf EA, Valero V, Tripathy D, Hortobagyi GN, Chavez-MacGregor M. Recurrence and survival among breast cancer patients achieving a pathological complete response to neoadjuvant chemotherapy. Breast Cancer Res Treat 2015; 153:417-23. [DOI: 10.1007/s10549-015-3533-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
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Beaver K, Williamson S, Briggs J. Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer. Eur J Oncol Nurs 2015; 20:77-86. [PMID: 26078034 DOI: 10.1016/j.ejon.2015.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Neo-adjuvant chemotherapy is recommended for 'inoperable' locally advanced and inflammatory breast cancers. For operable breast cancers, trials indicate no survival differences between chemotherapy given pre or post-surgery. Communicating evidence based information to patients is complex and studies examining patient experiences of neo-adjuvant chemotherapy are lacking. This study aims to explore the experiences of women who received neo-adjuvant chemotherapy for breast cancer. METHODS A qualitative approach using in-depth interviews with 20 women who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis. RESULTS The sample included a relatively young group of women, with caring responsibilities. Five main themes emerged: coping with the rapid transition from 'well' to 'ill', information needs and decision making, needing support and empathy, impact on family, and creating a new 'normal'. More support was needed towards the end of chemotherapy, when side effects were at their most toxic, and decisions about forthcoming surgery were being made. Some women were referred to psychological services, but usually when a crisis point had been reached. CONCLUSION Information and support would have been beneficial at key time points. This information is vital in developing services and interventions to meet the complex needs of these patients and potentially prevent late referral to psychological services. Specialist oncology nurses are able to develop empathetic relationships with patients and have the experience, knowledge and skills to inform and support women experiencing neo-adjuvant chemotherapy. Targeting key time points and maintaining relationship throughout neo-adjuvant chemotherapy would be highly beneficial.
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Affiliation(s)
- Kinta Beaver
- School of Health, University of Central Lancashire, Preston, UK.
| | - Susan Williamson
- School of Health, University of Central Lancashire, Preston, UK.
| | - Jean Briggs
- Department of Clinical Psychology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
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Zheng Y, Li S, Boohaker RJ, Liu X, Zhu Y, Zhai L, Li H, Gu F, Fan Y, Lang R, Liu F, Qian X, Xu B, Fu L. A MicroRNA Expression Signature In Taxane-anthracycline-Based Neoadjuvant Chemotherapy Response. J Cancer 2015; 6:671-7. [PMID: 26078798 PMCID: PMC4466417 DOI: 10.7150/jca.11616] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
There is an unmet clinical need to identify biomarkers for breast cancer neoadjuvant chemotherapy. Here, using miRNA TaqMan Low-Density Arrays (TLDA), we analyzed the miRNA expression profile in pre-treatment needle aspiration tumor samples from patients who received taxane-anthracycline-based neoadjuvant chemotherapy. Although, in an unsupervised hierarchical cluster analysis, the total miRNA expression profile could not generate a tree with clear distinction between pathologic complete response (pCR) and non-pCR classes, we found that elevated expression of miR-125b and miR-141 was associated with non-pCR. In vitro experiments indicated that inhibition of miR-125b and miR-141 expression reduced cellular survival in response to taxane-anthracycline treatment. Furthermore, co-transfection with miR-125b and miR-141 mimics increased resistance of MCF7 and BT549 cells to taxane-anthracycline induced cytotoxicity. Pathway analyses indicated that many of the target proteins of miR-125b are involved in apoptotic pathways and cell cycle control. Together, we provide evidence that elevated miR-125b and 141 expression predicts a poor clinical responsiveness of taxane-anthracycline-based neoadjuvant chemotherapy.
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Affiliation(s)
- Yi Zheng
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Shuai Li
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Rebecca J Boohaker
- 3. Department of Oncology, Southern Research Institute, Birmingham, AL 35205, USA
| | - Xinli Liu
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Yufen Zhu
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Lili Zhai
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Huilan Li
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Feng Gu
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Yu Fan
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Ronggang Lang
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Fangfang Liu
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Xiaolong Qian
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China
| | - Bo Xu
- 3. Department of Oncology, Southern Research Institute, Birmingham, AL 35205, USA
| | - Li Fu
- 1. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; State Key Laboratory of Breast Cancer Research, Hexi District, Tianjin, 300060, China ; 2. 2011 Collaborative Innovation Center of Tianjin for Medical Epigenetics
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Production and characterization of a novel long-acting Herceptin-targeted nanobubble contrast agent specific for Her-2-positive breast cancers. Breast Cancer 2015; 23:445-55. [PMID: 25691133 PMCID: PMC4839059 DOI: 10.1007/s12282-014-0581-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/26/2014] [Indexed: 11/12/2022]
Abstract
Background There is an unmet need for specific and sensitive imaging techniques to assess the efficacy of breast cancer therapy, particularly Her-2-expressing cancers. Ultrasonic microbubbles are being developed for use as diagnostic and therapeutic tools. However, nanobubbles circulate longer, are smaller, and diffuse into extravascular tissue to specifically bind target molecules. Here, we characterize a novel Herceptin-conjugated nanobubble for use against Her-2-expressing tumors. Methods Phospholipid-shelled nanobubbles conjugated with Herceptin (NBs-Her) were fabricated using a thin-film hydration method and characterized in vitro in breast cancer cell lines and in vivo in a mouse model. Results The average size of the unconjugated nanobubbles (NBs-Blank) and NBs-Her was 447.1 ± 18.4 and 613.0 ± 25.4 nm, respectively. In cell culture, the NBs-Her adhered to Her-2-positive cells significantly better than to Her-2-negative cells (p < 0.05). In vivo, the peak intensity and the half-time to washout of the NBs-Her were significantly greater than those of the NBs-Blank (p < 0.05). In addition, contrast-enhanced ultrasound imaging quality was improved through the use of the NBs-Her. The nanobubbles were able to penetrate into tumor tissue to allow extravascular imaging, but did not penetrate normal skeletal muscle. Conclusions The Herceptin-conjugated nanobubble had many properties that made it useful for in vivo imaging, including longer circulation time and better tumor selectivity. This platform may be able to provide targeted delivery of therapeutic drugs or genes.
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Balancing activity and tolerability of neoadjuvant paclitaxel- and docetaxel-based chemotherapy for HER2-positive early stage breast cancer: sensitivity analysis of randomized trials. Cancer Treat Rev 2015; 41:262-70. [PMID: 25683304 DOI: 10.1016/j.ctrv.2015.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 11/20/2022]
Abstract
Paclitaxel and docetaxel represent the most adopted taxanes in the neoadjuvant treatment of HER2-positive breast cancer. Questions still remain with regard to their difference in terms of activity and tolerability. Events for pathological complete response (pCR), severe and febrile neutropenia (FN), and severe neurotoxicity were pooled by adopting a fixed- and random-effect model. A sensitivity analysis to test for the interaction between paclitaxel and docetaxel was accomplished. Absolute differences with 95% confidence intervals (CIs) and the number of patients needed to treat/harm (NNT/NNH) were calculated to derive the Likelihood of being Helped or Harmed (LHH). Data from 15 trials (3601 patients) were included. Paclitaxel significantly increases pCR rate by 6.8% in comparison with docetaxel (43.4%, 95% CI 41.1-45.7% versus 36.6%, 95% CI 34.3-39.0%, p=0.0001), regardless of the chemotherapy backbone, with an absolute difference of 9% and 9.2% for anthracycline-based or free-regimens. Paclitaxel significantly improves pCR versus docetaxel with a single HER2-inhibition by 6.7% (p=0.0012), with no difference if combined with a dual HER2-inhibition. Severe neutropenia and FN are significantly lower with paclitaxel, with an absolute difference of 32.4% (p<0.0001) and 2.5% (p=0.0059), respectively. Conversely, severe neurotoxicity is slightly higher with paclitaxel (3%, p=0.0001). The LHH ratio calculated for pCR and severe neutropenia is 2.0 and 0.7 for paclitaxel and docetaxel. Although the activity of neoadjuvant paclitaxel and docetaxel HER2-positive breast cancer is considered similar, the slight advantage in pCR, the significantly lower neutropenia and FN, do favor paclitaxel (in the weekly fashion) over docetaxel, despite the slightly worst neurotoxicity.
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Sun J, Chen C, Yao X, Sun S. Lapatinib combined with neoadjuvant paclitaxel-trastuzumab-based chemotherapy in patients with human epidermal growth factor receptor 2-positive breast cancer: A meta-analysis of randomized controlled trials. Oncol Lett 2015; 9:1351-1358. [PMID: 25663912 PMCID: PMC4315003 DOI: 10.3892/ol.2015.2848] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022] Open
Abstract
The purpose of the present study was to quantify the cumulative randomized evidence for the efficacy and safety of lapatinib combined with neoadjuvant therapy in human epidermal growth factor receptor (HER) 2-positive breast cancer. Three electronic databases, MEDLINE, Embase and Cochrane Central Register of Controlled Trials, and the abstracts of major international conferences between inception and 15 December 2013 were searched. Two evaluators independently extracted data. The end-points assessed consisted of the pathological complete response (pCR) rate, breast-conserving surgery (BCS) rate and the occurrence of adverse events. Four randomized controlled trials were assessed in the present study, involving a total of 779 participants. Compared with the patients who did not receive lapatinib, the pCR rate was higher in the hormone receptor (HR)-positive [risk ratio (RR), 1.39; 95% confidence interval (CI), 1.12–1.72; P=0.002) and HR-negative (RR, 1.38; 95% CI, 1.14–1.68; P=0.0009) patients that received lapatinib. No significant difference between the BCS rate of the two treatment arms was observed in two trials (n=382; RR, 1.14; 95% CI, 0.89–1.47; P=0.31). The primary adverse events, including diarrhea, dermatological toxicity, hepatic toxicity and neutropenia, were statistically more frequent in patients that received lapatinib (RR, 2.46; 95% CI, 1.97–3.07; P<0.00001). The present analysis revealed that the addition of lapatinib to neoadjuvant chemotherapy for HER2-positive breast cancer improves the probability of achieving a higher pCR rate, but the use of lapatinib is associated with a higher risk of adverse events.
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Affiliation(s)
- Jinzhong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China ; Department of General Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang, Hubei, P.R. China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Xiaoli Yao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
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Baulies S, Cusidó M, González-Cao M, Tresserra F, Fargas F, Rodríguez I, Úbeda B, Ara C, Fábregas R. Hormone receptor and HER2 status: The only predictive factors of response to neoadjuvant chemotherapy in breast cancer. J OBSTET GYNAECOL 2014; 35:485-9. [PMID: 25383894 DOI: 10.3109/01443615.2014.968113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report our experience in neoadjuvant breast cancer chemotherapy in a single centre between 2000 and 2011. We looked for predictive factors for response to neoadjuvant chemotherapy in the present study. A total of 110 consecutive breast cancer patients were treated with neoadjuvant chemotherapy in our centre. Pathological response was achieved in 24 HR+/HER2- (38.7%), 25 HER2+ (67.6%) and five triple-negative (45.5%) (p = 0.02) patients. No statistically significant differences were found in pathological tumour response according to T stage. The multivariate analysis revealed tumour subtype was the only associated factor for pathological response, with HER2 + tumours the best responders, OR 3.9 (1.5-9.9): 5-year DFS was 40% HER2+/no response; 78% HER2+/response; 65% HR+/HER2-/no response; 82% HR+/HER2-/response; 25% triple-negative/no response and 100% triple-negative/response. HR and HER2 status were the only prognostic factors for pathological response. pCR was correlated with survival in all tumour subtypes.
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Affiliation(s)
- S Baulies
- a Gynecologic Oncology and Breast Pathology Section, Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - M Cusidó
- a Gynecologic Oncology and Breast Pathology Section, Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - M González-Cao
- b Department of Medical Oncology , Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - F Tresserra
- c Department of Pathology , Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - F Fargas
- a Gynecologic Oncology and Breast Pathology Section, Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - I Rodríguez
- d Statistics and Epidemiology Unit, Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - B Úbeda
- e Gynecologic Diagnostic Imaging, Department of Obstetrics , Gynecology and Human Reproduction, Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - C Ara
- a Gynecologic Oncology and Breast Pathology Section, Hospital Universitari Quirón Dexeus , Barcelona , Spain
| | - R Fábregas
- a Gynecologic Oncology and Breast Pathology Section, Hospital Universitari Quirón Dexeus , Barcelona , Spain
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Berruti A, Amoroso V, Gallo F, Bertaglia V, Simoncini E, Pedersini R, Ferrari L, Bottini A, Bruzzi P, Sormani MP. Pathologic complete response as a potential surrogate for the clinical outcome in patients with breast cancer after neoadjuvant therapy: a meta-regression of 29 randomized prospective studies. J Clin Oncol 2014; 32:3883-91. [PMID: 25349292 DOI: 10.1200/jco.2014.55.2836] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To assess the role of pathologic complete response (pCR) after neoadjuvant therapy as surrogate end point of disease-free survival (DFS) and overall survival (OS) in patients with breast cancer, we performed a trial-based meta-regression of randomized studies comparing different neoadjuvant systemic treatments. METHODS The systematic literature search included electronic databases and proceedings of oncologic meetings. Endocrine therapy trials were excluded. Treatment effects on DFS and OS were expressed as hazard ratios (HRs), and treatment effects on pCR were expressed as odds ratios (ORs). A weighted regression analysis was performed on log-transformed treatment effect estimates to test the association between treatment effects on the surrogate outcome and treatment effects on the clinical outcome. RESULTS Twenty-nine trials, 59 arms, and 30 comparisons, for a total of 14,641 patients, were included in the analysis. Using the complete set of data, the regression of either the log(HR) for DFS or the log(HR) for OS on the log(OR) for pCR demonstrated only weak associations (R(2) = 0.08; 95% CI, 0 to 0.47; and R(2) = 0.09; 95% CI, 0.01 to 0.41, respectively). Better associations were found in an exploratory analysis assessing a subset of trials comparing intensified/dose-dense chemotherapy versus standard-dose regimens (DFS: R(2) = 0.79; 95% CI, 0.26 to 0.95; P = .003; and OS: R(2) = 0.57; 95% CI, 0.19 to 0.93; P = .03). CONCLUSION This meta-regression analysis of 29 heterogeneous neoadjuvant trials does not support the use of pCR as a surrogate end point for DFS and OS in patients with breast cancer. However, pCR may potentially meet the criteria of surrogacy with specific systemic therapies.
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Affiliation(s)
- Alfredo Berruti
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy.
| | - Vito Amoroso
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Fabio Gallo
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Valentina Bertaglia
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Edda Simoncini
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Rebecca Pedersini
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Laura Ferrari
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Alberto Bottini
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Paolo Bruzzi
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
| | - Maria Pia Sormani
- Alfredo Berruti, Vito Amoroso, and Laura Ferrari, University of Brescia at Spedali Civili Hospital; Edda Simoncini and Rebecca Pedersini, Spedali Civili Hospital, Brescia; Fabio Gallo and Maria Pia Sormani, University of Genoa; Paolo Bruzzi, Istituto di Ricovero e Cura a Carattere Scientifico San Martino, Istituto Nazionale per la Ricerca sul Cancro, Genoa; Valentina Bertaglia, University of Turin, at San Luigi Gonzaga Hospital, Orbassano; and Alberto Bottini, Istituti Ospitalieri Hospital, Cremona, Italy
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Abstract
PURPOSE OF REVIEW Although neoadjuvant therapy (NAT) has become a popular approach in the systemic management of breast cancer, several important clinical questions remain unanswered. In this article, we review the literature pertaining to these questions and discuss the management strategies based on our findings. RECENT FINDINGS Currently, the optimal duration of NAT is unclear. At this time, there is no compelling data to support the extension of traditional neoadjuvant chemotherapy regimens. In patients with triple-negative breast cancer, pathologic complete response may be prognostic and the appropriate use of neoadjuvant chemotherapy is crucial to achieve improved survival. In human epidermal growth factor receptor 2 (HER2)-positive disease, it is reasonable to consider dual blockade with trastuzumab and pertuzumab in combination with a taxane in the neoadjuvant setting. Finally, there is currently no evidence to support the use of further adjuvant chemotherapy in those patients with residual disease after NAT. SUMMARY There remain many unanswered questions with the use of neoadjuvant chemotherapy in breast cancer, and further randomized clinical trials are needed. The results of these trials will permit the clinicians to develop 'personalized' treatment approaches, thus giving women the best chance of survival.
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Cardoso F, Costa A, Norton L, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordström EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van't Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)†. Ann Oncol 2014; 25:1871-1888. [PMID: 25234545 PMCID: PMC4176456 DOI: 10.1093/annonc/mdu385] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- F Cardoso
- European School of Oncology & Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
| | - A Costa
- European School of Oncology, Milan, Italy; European School of Oncology, Bellinzona, Switzerland
| | - L Norton
- Breast Cancer Program, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - M Aapro
- Division of Oncology, Institut Multidisciplinaire d'Oncologie, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - C H Barrios
- Department of Medicine, PUCRS School of Medicine, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology/Radiumhemmet, Karolinska Institutet & Cancer Center Karolinska and Karolinska University Hospital, Stockholm, Sweden
| | - L Biganzoli
- Department of Medical Oncology, Sandro Pitigliani Oncology Centre, Prato, Italy
| | - K L Blackwell
- Breast Cancer Clinical Program, Duke Cancer Institute, Durham, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - T Cufer
- University Clinic Golnik, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - N El Saghir
- NK Basile Cancer Institute Breast Center of Excellence, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - D Fenech
- Breast Care Support Group, Europa Donna Malta, Mtarfa, Malta
| | - P Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- BC Cancer Agency, Vancouver, Canada
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, USA
| | - J Gligorov
- APHP Tenon, IUC-UPMC, Francilian Breast Intergroup, AROME, Paris, France
| | - A Goldhirsch
- Program of Breast Health, European Institute of Oncology, Milan, Italy
| | - N Harbeck
- Brustzentrum der Universität München, Munich, Denmark
| | - N Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - C Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B Kaufman
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - U N Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - S D Merjaver
- University of Michigan Medical School and School of Public Health, Ann Arbor, USA
| | - E B Nordström
- Europa Donna Sweden & Bröstcancerföreningarnas Riksorganisation, BRO, Sundbyberg, Sweden
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - A Partridge
- Department Medical Oncology, Division of Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - F Penault-Llorca
- Jean Perrin Centre, Comprehensive Cancer Centre, Clermont Ferrand, France
| | - M J Piccart
- Department of Medicine, Institut Jules Bordet, Brussels, Belgium
| | - H Rugo
- Department of Medicine, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco
| | - G Sledge
- Indiana University Medical CTR, Indianapolis, USA
| | - C Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - L Van't Veer
- Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - D Vorobiof
- Sandton Oncology Centre, Johannesburg, South Africa
| | - C Vrieling
- Department of Radiotherapy, Clinique des Grangettes, Geneva, Switzerland
| | - N West
- Nursing Division, Health Board, Cardiff and Vale University, Cardiff, UK
| | - B Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - E Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
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64
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Chen XS, Yuan Y, Garfield DH, Wu JY, Huang O, Shen KW. Both carboplatin and bevacizumab improve pathological complete remission rate in neoadjuvant treatment of triple negative breast cancer: a meta-analysis. PLoS One 2014; 9:e108405. [PMID: 25247558 PMCID: PMC4172579 DOI: 10.1371/journal.pone.0108405] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/27/2014] [Indexed: 12/31/2022] Open
Abstract
Triple negative breast cancer (TNBC) is associated with high pathological complete remission (pCR) rate in neoadjuvant treatment (NAT). TNBC patients who achieve pCR have superior outcome than those without pCR. A meta-analysis was done to evaluate whether integrating novel approaches into NAT can improve the pCR rate in TNBC. Medical subject heading terms (Breast Neoplasm) and key words (triple negative OR estrogen receptor (ER) negative OR HER2 negative) AND (primary systemic OR neoadjuvant OR preoperative) were used to select eligible studies. Experimental arm in each study was considered as the testing regimen, and control arm was defined as the standard regimen in this meta-analysis. A total of 11 studies with 14 paired regimens were included in the final analysis. Aggregate pCR rate was 37.3% and 44.6% in the standard and testing group, respectively. Novel approaches in the testing regimen significantly improved the pCR rate in NAT of TNBC patients compared with the standard regimen, with an odds ratio (OR) of 1.34 (95% confidence interval (CI) 1.11-1.62, P = 0.002). Considering specific regimens, we demonstrated the pCR rate to be much higher in the carboplatin-containing (OR = 1.80, 95% CI 1.39-2.32, P<0.001) or bevacizumab-containing regimens (OR = 1.36, 95% CI 1.11-1.66, P = 0.003) than in the control regimens. The addition of carboplatin in NAT had a pCR rate as high as 51.2% in TNBC patients, with an absolute pCR difference of 13.8% as compared with control regimens. No significant heterogeneity was identified among studies evaluating the addition of carboplatin or bevacizumab efficacy in NAT. This meta-analysis indicates that these novel NAT regimens have achieved a significant pCR improvement in TNBC patients, especially among patients treated with carboplatin-containing or bevacizumab-containing regimen. This can help us design appropriate trials in the adjuvant setting and guide clinical practice.
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Affiliation(s)
- Xiao-song Chen
- Comprehensive Breast Health Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Yuan
- Department of Radiology, Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - David H. Garfield
- University of Colorado Comprehensive Cancer Center, Aurora, Colorado, United States of America
| | - Jia-yi Wu
- Comprehensive Breast Health Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kun-wei Shen
- Comprehensive Breast Health Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
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65
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Cardoso F, Costa A, Norton L, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Biganzoli L, Blackwell KL, Cardoso MJ, Cufer T, El Saghir N, Fallowfield L, Fenech D, Francis P, Gelmon K, Giordano SH, Gligorov J, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Krop I, Kyriakides S, Lin UN, Mayer M, Merjaver SD, Nordström EB, Pagani O, Partridge A, Penault-Llorca F, Piccart MJ, Rugo H, Sledge G, Thomssen C, Van't Veer L, Vorobiof D, Vrieling C, West N, Xu B, Winer E. ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2). Breast 2014; 23:489-502. [PMID: 25244983 DOI: 10.1016/j.breast.2014.08.009] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/12/2014] [Indexed: 12/25/2022] Open
Affiliation(s)
- F Cardoso
- European School of Oncology & Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
| | - A Costa
- European School of Oncology, Milan, Italy; European School of Oncology, Bellinzona, Switzerland
| | - L Norton
- Breast Cancer Program, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - M Aapro
- Division of Oncology, Institut Multidisciplinaire d'Oncologie, Genolier, Switzerland
| | - F André
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - C H Barrios
- Department of Medicine, PUCRS School of Medicine, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology/Radiumhemmet, Karolinska Institutet & Cancer Center Karolinska and Karolinska University Hospital, Stockholm, Sweden
| | - L Biganzoli
- Department of Medical Oncology, Sandro Pitigliani Oncology Centre, Prato, Italy
| | - K L Blackwell
- Breast Cancer Clinical Program, Duke Cancer Institute, Durham, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - T Cufer
- University Clinic Golnik, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - N El Saghir
- NK Basile Cancer Institute Breast Center of Excellence, American University of Beirut Medical Center, Beirut, Lebanon
| | - L Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - D Fenech
- Breast Care Support Group, Europa Donna Malta, Mtarfa, Malta
| | - P Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gelmon
- BC Cancer Agency, Vancouver, Canada
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, UT MD Anderson Cancer Center, Houston, USA
| | - J Gligorov
- APHP Tenon, IUC-UPMC, Francilian Breast Intergroup, Arome, Paris, France
| | - A Goldhirsch
- Program of Breast Health, European Institute of Oncology, Milan, Italy
| | - N Harbeck
- Brustzentrum der Universität München, Munich, DE, USA
| | - N Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - C Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B Kaufman
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | - U N Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Mayer
- Advanced BC.org, New York, USA
| | - S D Merjaver
- University of Michigan Medical School and School of Public Health, Ann Arbor, USA
| | - E B Nordström
- Europa Donna Sweden & Bröstcancerföreningarnas Riksorganisation, BRO, Sundbyberg, Sweden
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | - A Partridge
- Department Medical Oncology, Division of Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - F Penault-Llorca
- Jean Perrin Centre, Comprehensive Cancer Centre, Clermont Ferrand, France
| | - M J Piccart
- Department of Medicine, Institut Jules Bordet, Brussels, Belgium
| | - H Rugo
- Department of Medicine, Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - G Sledge
- Indiana University Medical CTR, Indianapolis, USA
| | - C Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, DE, Germany
| | - L Van't Veer
- Breast Oncology Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - D Vorobiof
- Sandton Oncology Centre, Johannesburg, South Africa
| | - C Vrieling
- Department of Radiotherapy, Clinique des Grangettes, Geneva, Switzerland
| | - N West
- Nursing Division, Health Board, Cardiff and Vale University, Cardiff, UK
| | - B Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - E Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
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66
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Teruel JR, Heldahl MG, Goa PE, Pickles M, Lundgren S, Bathen TF, Gibbs P. Dynamic contrast-enhanced MRI texture analysis for pretreatment prediction of clinical and pathological response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. NMR IN BIOMEDICINE 2014; 27:887-896. [PMID: 24840393 DOI: 10.1002/nbm.3132] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to investigate the potential of texture analysis, applied to dynamic contrast-enhanced MRI (DCE-MRI), to predict the clinical and pathological response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer (LABC) before NAC is started. Fifty-eight patients with LABC were classified on the basis of their clinical response according to the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines after four cycles of NAC, and according to their pathological response after surgery. T1 -weighted DCE-MRI with a temporal resolution of 1 min was acquired on a 3-T Siemens Trio scanner using a dedicated four-channel breast coil before the onset of treatment. Each lesion was segmented semi-automatically using the 2-min post-contrast subtracted image. Sixteen texture features were obtained at each non-subtracted post-contrast time point using a gray level co-occurrence matrix. Appropriate statistical analyses were performed and false discovery rate-based q values were reported to correct for multiple comparisons. Statistically significant results were found at 1-3 min post-contrast for various texture features for the prediction of both the clinical and pathological response. In particular, eight texture features were found to be statistically significant at 2 min post-contrast, the most significant feature yielding an area under the curve (AUC) of 0.77 for response prediction for stable disease versus complete responders after four cycles of NAC. In addition, four texture features were found to be significant at the same time point, with an AUC of 0.69 for response prediction using the most significant feature for classification based on the pathological response. Our results suggest that texture analysis could provide clinicians with additional information to increase the accuracy of prediction of an individual response before NAC is started.
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Affiliation(s)
- Jose R Teruel
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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67
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Reis I, Pereira H, Azevedo I, Conde J, Bravo I, Craveiro R, Pereira D. Breast cancer local recurrence under the form of inflammatory carcinoma, treated with concurrent radiation and chemotherapy, a case report. Rep Pract Oncol Radiother 2014; 19:65-8. [PMID: 24936322 DOI: 10.1016/j.rpor.2013.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/08/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022] Open
Abstract
The authors present a case report of a patient with breast cancer diagnosed in 2005, treated with conservative surgery, adjuvant chemotherapy and radiotherapy, followed by hormonal therapy until 2010, who relapsed under the form of inflammatory breast cancer in 2011. After tumor progression detected during primary systemic therapy, a concurrent radiation and radiosensitizing chemotherapy were proposed. There was a significant clinical response to this treatment, enabling curative chance with total mastectomy. The histological examination of the breast and regional lymph nodes revealed a complete response, since there was no evidence of residual tumor. There are few reports concerning concurrent radiotherapy and chemotherapy in locally advanced breast cancer, but it could be a suitable "loco regional rescue therapy" to further reduce tumor progression and allow curative surgery. Study of this treatment strategy in randomized clinical trials is warranted.
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Affiliation(s)
- Isabel Reis
- Radiation Oncology Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
| | - Helena Pereira
- Radiation Oncology Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
| | - Isabel Azevedo
- Radiation Oncology Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
| | - João Conde
- Radiation Oncology Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
| | - Isabel Bravo
- Radiobiology Lab, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
| | - Rogéria Craveiro
- Radiobiology Lab, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
| | - Deolinda Pereira
- Oncology Department, Instituto Português de Oncologia Francisco Gentil do Porto, E.P.E., Porto, Portugal
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68
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Chin SN, Green CMA, Gordon-Strachan GM, Wharfe GHF. Locally advanced breast cancer in Jamaica: prevalence, disease characteristics and response to preoperative therapy. Asian Pac J Cancer Prev 2014; 15:3323-6. [PMID: 24815490 DOI: 10.7314/apjcp.2014.15.7.3323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is the most common cancer in Jamaican women. Locally advanced breast cancer (LABC) is associated with aggressive biology and poor prognosis, and has a predilection for African-American women. In this retrospective review, we assessed the prevalence of LABC as a breast cancer presentation in a population of mainly Afro-centric ethnicity, and determined disease characteristics and response to pre-operative chemotherapy. LABC was prevalent (20%), and had a low pathological response rate to pre-operative chemotherapy, with a high risk of disease recurrence. Increased utilization of breast cancer screening may help detect cancer at less advanced stages, and optimizing pre-operative chemotherapy is recommended to improve response rates and ultimately survival.
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Affiliation(s)
- Sheray Nicole Chin
- Department of Pathology, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica E-mail :
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69
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Abstract
Staging at initial presentation is one of the important prognostic factors for patients with breast cancer. Depending on the extent of disease spread, staging is divided into locoregional and distant or systemic. Locoregional staging includes axillary and internal mammary lymph node evaluation and distant or systemic staging includes evaluation of sites beyond the lymph node. Fluorodeoxyglucose-positron emission tomography (FDG-PET) is not sensitive to detect small metastasis in axillary lymph node. The current standard of axillary lymph node staging in early-stage breast cancer is therefore sentinel lymph node biopsy. Internal mammary lymph nodes are not commonly included in routine staging. In advanced-stage breast cancer, FDG-PET and PET/computed tomography (CT) are the modalities of choice to evaluate locoregional and distant metastasis. FDG-PET and PET/CT often detect occult metastasis, which is not visible on any other modalities including diagnostic CT scan. Detection of occult metastasis may potentially change in treatment options. This is particularly important in locally advanced breast cancer, which tends to develop early distant metastasis.
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Affiliation(s)
- Jean H Lee
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
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71
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Ueno T, Masuda N, Yamanaka T, Saji S, Kuroi K, Sato N, Takei H, Yamamoto Y, Ohno S, Yamashita H, Hisamatsu K, Aogi K, Iwata H, Sasano H, Toi M. Evaluating the 21-gene assay Recurrence Score® as a predictor of clinical response to 24 weeks of neoadjuvant exemestane in estrogen receptor-positive breast cancer. Int J Clin Oncol 2013; 19:607-13. [PMID: 24101215 DOI: 10.1007/s10147-013-0614-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/19/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association between the results of the Recurrence Score (RS) assay and the clinical response to neoadjuvant endocrine therapy in postmenopausal women with breast cancer. METHODS Core biopsy samples at baseline and post-treatment surgical samples were obtained from 80 and 77 of 116 patients, respectively, enrolled in the multicenter prospective study of neoadjuvant exemestane therapy (JFMC34-0601). The 21-gene assay was performed after appropriate manual microdissection. The estrogen receptor (ER), progesterone receptor, HER2 and Ki-67 were assayed by immunohistochemistry at a central laboratory. Clinical response was assessed based on the RECIST (Response Evaluation Criteria In Solid Tumors) guideline. RESULTS Sixty-four core biopsy samples and 52 resection samples met the RS quality requirements. The clinical response rate in those patients with a low RS result (low RS group; 19/32, 59.4 %) was significantly higher than that in those patients with a high RS result (high RS group; 3/15, 20.0 %) (P = 0.015) and similar to that in patients with an intermediate RS result (intermediate RS group; 10/17, 58.8 %). The rates of breast-conserving surgery (BCS) were 90.6 % (29/32) in the low RS group, 76.5 % (13/17) in the intermediate RS group and 46.7 % (7/15) in the high RS group. The odds ratio for BCS adjusted for continuous baseline Ki-67 was 0.114 [95 % confidence interval (CI) 0.014-0.721; P = 0.028] between the high and low RS groups. RS values in pre-treatment samples were highly correlated with those in post-treatment samples (Spearman correlation coefficient 0.745, 95 % CI 0.592-0.846). CONCLUSION Our results demonstrate the predictive value of the RS for clinical response to neoadjuvant exemestane therapy in postmenopausal women with ER-positive breast cancer.
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Affiliation(s)
- Takayuki Ueno
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Ge J, Tian AX, Wang QS, Kong PZ, Yu Y, Li XQ, Cao XC, Feng YM. The GSTP1 105Val allele increases breast cancer risk and aggressiveness but enhances response to cyclophosphamide chemotherapy in North China. PLoS One 2013; 8:e67589. [PMID: 23826324 PMCID: PMC3691318 DOI: 10.1371/journal.pone.0067589] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/20/2013] [Indexed: 12/22/2022] Open
Abstract
The glutathione-S-transferase (GST) family contributes to the inactivation of various toxic compounds formed as secondary metabolites during oxidative stress. GSTP1 accounts for the majority of the GST family enzymatic activity, and the activity of GSTP1 enzyme can be altered by the presence of the Ile105Val polymorphism. In this study, we examined the polymorphic frequency of GSTP1 Ile105Val genotype in 920 breast cancer patients and 783 healthy controls in women of North China. Results showed that GSTP1 105Val allele (Ile/Val and Val/Val) was associated with a higher breast cancer risk (OR = 1.38, 95% CI: 1.14–1.69; P = 0.001) and more aggressive tumors with histological grade III (OR = 1.15, 95% CI: 1.05–1.26; P = 0.001), lymph node metastases (OR = 2.35, 95% CI: 1.72–3.21; P < 0.001), as well as ER negative (OR = 1.77, 95% CI: 1.31–2.39; P < 0.001) than those carrying the Ile/Ile allele. However, the patients with the GSTP1 105Val genotype had a better disease free survival after cyclophosphamide (CTX)-based chemotherapy than those with Ile/Ile (HR = 0.77, 95% CI: 0.45–0.91; P < 0.001). Furthermore, in vitro cellular experiments demonstrated that breast cancer cells with the GSTP1 105Val allele were significantly more sensitive to CTX-induced proliferation inhibition. Thus, we conclude that the GSTP1 105Val allele increases breast cancer risk and aggressiveness and enhance response to CTX-based chemotherapy in women of North China. Detection of the GSTP1 Ile105Val genotype may help screen for high-risk populations and direct individualized therapy.
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Affiliation(s)
- Jie Ge
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Department of Breast surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Treatment of the Ministry of Education, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ai-Xian Tian
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Qing-Shan Wang
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Treatment of the Ministry of Education, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Peng-Zhou Kong
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yue Yu
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiao-Qing Li
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Treatment of the Ministry of Education, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xu-Chen Cao
- Department of Breast surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Treatment of the Ministry of Education, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yu-Mei Feng
- Department of Biochemistry and Molecular Biology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Key Laboratory of Breast Cancer Prevention and Treatment of the Ministry of Education, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- * E-mail:
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Fernandez SV, Robertson FM, Pei J, Aburto-Chumpitaz L, Mu Z, Chu K, Alpaugh RK, Huang Y, Cao Y, Ye Z, Cai KQ, Boley KM, Klein-Szanto AJ, Devarajan K, Addya S, Cristofanilli M. Inflammatory breast cancer (IBC): clues for targeted therapies. Breast Cancer Res Treat 2013; 140:23-33. [PMID: 23784380 PMCID: PMC4273486 DOI: 10.1007/s10549-013-2600-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/06/2013] [Indexed: 01/26/2023]
Abstract
Inflammatory breast cancer (IBC) is the most aggressive type of advanced breast cancer characterized by rapid proliferation, early metastatic development and poor prognosis. Since there are few preclinical models of IBC, there is a general lack of understanding of the complexity of the disease. Recently, we have developed a new model of IBC derived from the pleural effusion of a woman with metastatic secondary IBC. FC-IBC02 cells are triple negative and form clusters (mammospheres) in suspension that are strongly positive for E-cadherin, β-catenin and TSPAN24, all adhesion molecules that play an important role in cell migration and invasion. FC-IBC02 cells expressed stem cell markers and some, but not all of the characteristics of cells undergoing epithelial mesenchymal transition (EMT). Breast tumor FC-IBC02 xenografts developed quickly in SCID mice with the presence of tumor emboli and the development of lymph node and lung metastases. Remarkably, FC-IBC02 cells were able to produce brain metastasis in mice on intracardiac or intraperitoneal injections. Genomic studies of FC-IBC02 and other IBC cell lines showed that IBC cells had important amplification of 8q24 where MYC, ATAD2 and the focal adhesion kinase FAK1 are located. MYC and ATAD2 showed between 2.5 and 7 copies in IBC cells. FAK1, which plays important roles in anoikis resistance and tumor metastasis, showed 6–4 copies in IBC cells. Also, CD44 was amplified in triple-negative IBC cells (10–3 copies). Additionally, FC-IBC02 showed amplification of ALK and NOTCH3. These results indicate that MYC, ATAD2, CD44, NOTCH3, ALK and/or FAK1 may be used as potential targeted therapies against IBC.
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Richard R, Thomassin I, Chapellier M, Scemama A, de Cremoux P, Varna M, Giacchetti S, Espié M, de Kerviler E, de Bazelaire C. Diffusion-weighted MRI in pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol 2013; 23:2420-31. [PMID: 23652844 DOI: 10.1007/s00330-013-2850-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/26/2013] [Accepted: 02/26/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the accuracy of the apparent diffusion coefficient (ADC) provided by diffusion-weighted imaging (DWI) in predicting the response to neoadjuvant chemotherapy (NACT) at baseline in patients according to their breast tumour phenotypes. MATERIALS & METHODS This retrospective study was approved by our institutional review board. One hundred eighteen consecutive women with locally advanced breast cancer who had undergone NACT followed by breast surgery were included. DWI was performed at 1.5 T less than 2 weeks before NACT. We studied the correlation between pretreatment ADC and response in pathology after surgery according to immunohistochemical features and intrinsic subtypes (luminal A, luminal B, HER2-enriched, and triple-negative tumours). RESULTS After surgery, the pathologist recognized 24 complete responders (CRps) and 94 non-complete responders (NCRps). No difference was identified between the pretreatment ADCs of the CRp and NCRp patients. There were differences in pretreatment ADCs among the luminal A (1.001 ± 0.143 × 10(-3) mm(2)/s), luminal B (0.983 ± 0.150 × 10(-3) mm(2)/s), HER2-enriched (1.132 ± 0.216 × 10(-3) mm(2)/s), and triple-negative (1.168 ± 0.245 × 10(-3) mm(2)/s; P = 0.0003) tumour subtypes. In triple-negative tumours, the pretreatment ADC was higher in NCRp (1.060 ± 0.143 × 10(-3) mm(2)/s) than in CRp patients (1.227 ± 0.271 × 10(-3) mm(2)/s; P = 0.047). CONCLUSION Pretreatment ADC can predict the response of breast cancer to NACT if tumour subtypes are considered. Key Points • Apparent diffusion coefficient helps clinicians to assess patients with breast cancer. • Pretreatment ADC is related to tumour grade and hormone receptor status. • Pretreatment ADC is lower in luminal A and B than in triple-negative tumours. • Pretreatment ADC is higher in complete than in non-complete responders to neoadjuvant chemotherapy.
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Affiliation(s)
- Raphael Richard
- Radiology Department, Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75010, Paris, France.
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75
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Truin W, Voogd AC, Vreugdenhil G, van der Heiden-van der Loo M, Siesling S, Roumen RM. Effect of adjuvant chemotherapy in postmenopausal patients with invasive ductal versus lobular breast cancer. Ann Oncol 2012; 23:2859-2865. [PMID: 22745216 DOI: 10.1093/annonc/mds180] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND On the basis of the lack of response of invasive lobular breast cancer to neoadjuvant chemotherapy, we questioned the effectiveness of adjuvant chemotherapy in relation to histology. PATIENTS AND METHODS Women with primary nonmetastatic invasive ductal or (mixed type) lobular breast cancer, aged 50-70 years, diagnosed between 1995 and 2008, were selected from the Netherlands Cancer Registry and followed until January 1, 2010. The patients were divided in two groups: one group receiving adjuvant hormonal therapy only and the other receiving adjuvant hormonal therapy in combination with adjuvant chemotherapy. RESULTS In total, 19,609 patients had ductal cancer and 3685 had lobular cancer. The 10-year overall survival rate in ductal cancer when treated with hormonal therapy alone was 69%, compared with 74% with the combination therapy (P < 0.0001). In lobular cancer, 10-year survival rates were 68% after hormonal treatment alone and 66% after the combination therapy (P = 0.45). The hazard ratio (HR) for mortality in ductal cancer after combination therapy was 0.70 [95% confidence interval (CI) 0.64-0.76; P < 0.0001], compared with hormonal treatment alone. The HR in lobular cancer was 1.00 (95% CI 0.82-1.21; P = 0.97). CONCLUSION Adjuvant chemotherapy seems to confer no additional beneficial effects in postmenopausal patients with pure or mixed type lobular breast cancer receiving hormonal therapy.
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MESH Headings
- Aged
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/surgery
- Chemotherapy, Adjuvant
- Female
- Humans
- Middle Aged
- Neoadjuvant Therapy
- Postmenopause
- Survival Rate
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Affiliation(s)
- W Truin
- Department of Surgery, Máxima Medical Centre, Veldhoven.
| | - A C Voogd
- Department of Epidemiology, School GROW, Maastricht University Medical Centre, Maastricht; Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven
| | - G Vreugdenhil
- Department of Internal Medicine, Máxima Medical Centre, Veldhoven
| | | | - S Siesling
- Department of Research, Comprehensive Cancer Centre the Netherlands, Enschede; Department of Health Technology and Services Research, Twente University, Enschede, The Netherlands
| | - R M Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven
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Valachis A, Nearchou A, Lind P, Mauri D. Lapatinib, trastuzumab or the combination added to preoperative chemotherapy for breast cancer: a meta-analysis of randomized evidence. Breast Cancer Res Treat 2012; 135:655-62. [PMID: 22875745 DOI: 10.1007/s10549-012-2189-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 07/25/2012] [Indexed: 11/27/2022]
Abstract
We compared the efficacy and safety of the addition of lapatinib versus trastuzumab or their combination to neoadjuvant chemotherapy in HER2-positive breast cancer. Potentially eligible trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences. The endpoints that we assessed were pathologic complete response (pCR) rate, and toxicity. Pooled risk ratios (RR) were estimated for each endpoint with fixed or random effects models, depending on between studies heterogeneity. Six trials were identified with 1,494 eligible patients. The probability to achieve pCR was higher for the trastuzumab plus chemotherapy arm versus lapatinib plus chemotherapy (RR 1.25, 95 % confidence interval [CI] 1.08-1.43; p = 0.003) (6 trials; 1,494 patients). Probability to pCR was significantly higher in the group receiving lapatinib and trastuzumab than in the group with trastuzumab alone (RR 1.39, 95 % CI 1.20-1.63; p < 0.001) (4 trials; 779 patients). Grade III-IV diarrhea and dermatologic toxicities were statistically more frequent in patients receiving lapatinib. No differences were observed regarding cardiac adverse events among patients receiving trastuzumab, lapatinib, or their combination. These data supports the superiority of a dual-HER2 inhibition for the treatment of HER2-positive breast cancer in the neoadjuvant setting. The direct comparison of trastuzumab and lapatinib showed that lapatinib is inferior in terms of pCR and associated with a higher risk for toxicity.
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Aogi K, Saeki T, Nakamura S, Kashiwaba M, Sato N, Masuda N, Rai Y, Ohno S, Kuroi K, Nishimura R, Miyakoda K, Akiyama F, Kurosumi M, Ikeda T. A multicenter, phase II study of epirubicin/cyclophosphamide followed by docetaxel and concurrent trastuzumab as primary systemic therapy for HER-2 positive advanced breast cancer (the HER2NAT study). Int J Clin Oncol 2012; 18:598-606. [PMID: 22833344 DOI: 10.1007/s10147-012-0437-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 06/07/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND The outcome in patients with human epidermal growth factor receptor-2 (HER-2)-positive locally advanced breast cancer may be improved by integrating trastuzumab with primary systemic therapy (PST). METHODS The efficacy and safety of PST comprising EC (epirubicin 90 mg/m(2) and cyclophosphamide 600 mg/m(2), four cycles every 3 weeks) followed by docetaxel (75 mg/m(2), four cycles every 3 weeks) and concurrent trastuzumab (loading dose 4 mg/kg followed by 2 mg/kg, 12 cycles every week) was investigated in a multicenter, prospective, phase II study in patients with HER-2-positive stage IIIB/IIIC/IV breast cancer. The primary endpoint was pathologic complete response (pCR) including the tumor intraductal component confirmed by central pathologic review. RESULTS In total, 38 patients were enrolled (stage IIIB, 63.2 %; IIIC, 23.7 %; IV, 13.2 %; estrogen receptor- and/or progesterone receptor-positive, 47.4 %). The pCR rate was 16.2 % in the primary tumor (six of 37 patients in the Full Analysis Set) and 56.8 % (21/37) in the ipsilateral axillary lymph nodes. Treatment was given according to protocol in 28 of 37 patients; six of 28 in the Per-Protocol Set achieved pCR (21.4 %). The clinical response rate was 67.6 % (25/37 patients; complete response, 13.5 %; partial response, 54.1 %). No patients developed congestive heart failure; however, three patients had a non-symptomatic decrease of >10 % of left ventricular ejection fraction. CONCLUSIONS PST including concurrent use of trastuzumab combined with docetaxel is effective and well-tolerated in HER-2-positive advanced breast cancer patients, including those patients requiring mastectomy for local control.
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Affiliation(s)
- Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
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Oh E, Chim H, Soltanian HT. The effects of neoadjuvant and adjuvant chemotherapy on the surgical outcomes of breast reconstruction. J Plast Reconstr Aesthet Surg 2012; 65:e267-80. [PMID: 22633392 DOI: 10.1016/j.bjps.2012.04.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/24/2012] [Accepted: 04/30/2012] [Indexed: 12/26/2022]
Abstract
Breast reconstruction following mastectomy has become, in many centers the standard of care. An increasingly encountered trend is the use of neoadjuvant chemotherapy to downstage high stage tumors and to decrease tumor burden prior to definitive oncologic surgery. These agents clearly provide a survival benefit, but also have the potential to adversely affect the surgical course of immediate and delayed breast reconstruction. The use of new biologic and hormonal agents may also have effects on surgery and reconstruction. Furthermore, chemotherapeutic agents as a whole may impair cellular functions necessary for normal recovery from surgery. In this paper we present a concise review for the reconstructive surgeon on adverse effects of chemotherapeutic, hormonal and biologic agents used for treatment of breast cancer, important perioperative issues, and also discuss their potential effect on breast reconstruction.
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Affiliation(s)
- Eugene Oh
- Department of Plastic Surgery, Case School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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79
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Magnetic resonance imaging evaluation of residual ductal carcinoma in situ following preoperative chemotherapy in breast cancer patients. Eur J Radiol 2012; 81:737-43. [DOI: 10.1016/j.ejrad.2011.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/05/2011] [Accepted: 01/05/2011] [Indexed: 11/23/2022]
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Abstract
OBJECTIVE The aim of this study was to evaluate the features of inflammatory breast carcinoma (IBC) on MRI compared with mammography and ultrasound and to better define the role of MRI in patients with this aggressive disease. MATERIALS AND METHODS A retrospective analysis was performed of patients with newly diagnosed IBC evaluated at a single institution between 2003 and 2008. Baseline MRI examinations were performed on a 1.5- or 3-T scanner using contrast-enhanced 3D T1-weighted gradient-echo sequences with parallel imaging. MRI findings were rated in accordance with the BI-RADS MRI lexicon established by the American College of Radiology. All patients underwent concomitant mammography and ultrasound examinations. RESULTS Eighty women with a clinical diagnosis of IBC were included in the study (median age, 52 years; age range, 25-78 years). MRI detected a primary breast lesion in 78 of 80 symptomatic breasts (98%) compared with 53 of 78 (68%) with mammography (p < 0.0001) and 75 of 80 (94%) with ultrasound. Of the 78 breasts with a primary lesion, the most common MRI finding was a mass or multiple masses (57/78, 73%). Masses were frequently multiple, small, and confluent (47/57, 82%); mass margins, irregular (43/57, 75%); and internal enhancement pattern, heterogeneous (47/57, 82%). Kinetic analysis revealed a delayed washout pattern in 66 of 78 tumors (85%). MRI showed skin thickening in 74 of 80 breasts (93%), whereas mammography showed skin thickening in 56 of 78 breasts (72%). CONCLUSION Multiple small, confluent, heterogeneously enhancing masses and global skin thickening are key MRI features of IBC that contribute to improved detection of a primary breast cancer and delineation of disease extent compared with mammography.
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Vicente Conesa MA, Garcia-Martinez E, Gonzalez Billalabeitia E, Chaves Benito A, Garcia Garcia T, Vicente Garcia V, Ayala de la Peña F. Predictive value of peripheral blood lymphocyte count in breast cancer patients treated with primary chemotherapy. Breast 2011; 21:468-74. [PMID: 22119767 DOI: 10.1016/j.breast.2011.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 09/21/2011] [Accepted: 11/03/2011] [Indexed: 01/30/2023] Open
Abstract
Peripheral blood lymphocyte (PBL) count may reflect the immune status of cancer patients. We retrospectively analyzed the predictive and prognostic impact of baseline and post-chemotherapy PBL counts in a homogeneous group of 103 breast cancer patients treated with neoadjuvant chemotherapy (anthracyclines and taxanes). In univariate analysis, baseline PBL under 1500 × 10(6)/L (p = 0.013; hazard ratio [HR]: 2.80, 95%CI 1.24-6.61), and PBL decrease >200 × 10(6)/L after the first cycle of chemotherapy (p = 0.047; HR: 2.82, 95%CI 1.01-7.86) were significantly related to disease free survival. In multivariate analysis, both baseline PBL count less than 1500 × 10(6)/L (p = 0.034; HR: 3.32, 95%CI 1.09-10.02) and PBL decrease >200 × 10(6)/L after first cycle (p = 0.032; HR: 3.25, 95%CI 1.10-9.56) showed independent prognostic value for worse disease free survival. No effect was observed for overall survival. Our data support the relevance of pre- and post-chemotherapy PBL for breast cancer recurrence after neoadjuvant chemotherapy.
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83
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Lemieux J, Clemons M, Provencher L, Dent S, Latreille J, Mackey J, Pritchard KI, Rayson D, Verma S, Verma S, Wang B, Chia S. The role of neoadjuvant (HER)2-targeted therapies in (HER)2-overexpressing breast cancers. ACTA ACUST UNITED AC 2011; 16:48-57. [PMID: 19862361 PMCID: PMC2768514 DOI: 10.3747/co.v16i5.510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Women receiving neoadjuvant systemic therapy for primary operable or inoperable breast cancer can potentially benefit in a number of ways, but the main advantage, which has been consistently demonstrated, is improved tumour resectability. Given the improvement in outcomes with the adjuvant use of trastuzumab in patients with early-stage breast cancer positive for the human epidermal growth factor receptor 2 (her2), questions have been raised about the use of trastuzumab in the neoadjuvant setting. The present paper reviews the currently available data and outlines suggestions from a panel of Canadian oncologists about the use of trastuzumab and other her2-targeted agents in the neoadjuvant setting. The panel focussed on the use of trastuzumab and other her2-targeted agents as neoadjuvant therapy in primary operable, locally advanced, and inflammatory breast cancer; and possible choices of chemotherapeutic regimens with trastuzumab.
The suggestions described here will continue to evolve as data from current and future trials with trastuzumab and other her2-targeted agents emerge.
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Affiliation(s)
- J Lemieux
- Unité de recherche en santé des populations, Centre de Recherche du Centre Hospitalier affilié universitaire de Québec, Quebec City, QC.
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Mohammadianpanah M, Ashouri Y, Hoseini S, Amadloo N, Talei A, Tahmasebi S, Nasrolahi H, Mosalaei A, Omidvari S, Ansari M, Mosleh-Shirazi MA. The efficacy and safety of neoadjuvant chemotherapy +/- letrozole in postmenopausal women with locally advanced breast cancer: a randomized phase III clinical trial. Breast Cancer Res Treat 2011; 132:853-61. [PMID: 22002564 DOI: 10.1007/s10549-011-1814-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 09/30/2011] [Indexed: 01/28/2023]
Abstract
This two-arm randomized clinical study aimed to evaluate the efficacy and safety of neoadjuvant concurrent chemotherapy and letrozole in postmenopausal women with locally advanced breast carcinoma. One hundred and one postmenopausal women aged 50-83 years with pathologically proven locally advanced (clinical stage T3, T4 and/or N2, N3) breast cancer were randomly assigned to receive neoadjuvant chemotherapy alone (control arm, n = 51) or neoadjuvant chemotherapy concurrent with letrozole 2.5 mg (study arm, n = 50). Chemotherapy consisted of a median 4 (range 3-5) cycles of intravenous 5-fluorouracil 600 mg/m(2), doxorubicin 60 mg/m(2), and cyclophosphamide 600 mg/m(2), every three weeks. All patients subsequently underwent modified radical mastectomy approximately two weeks after the last cycle of chemotherapy. Pathologic complete response rates were 25.5% and 10.2% in the study and the control group, respectively (P = 0.049). Similarly, clinical complete response rates were 27.6% and 10.2% in the study and the control group, respectively (P = 0.037). In the subgroup analysis of hormone receptor-positive cases, the complete response rates were more prominent in study group compared with control group. Common treatment-related side effects such as nausea, vomiting, bone marrow suppression, and mucositis were similar in both groups, but hot flush was more prevalent in study group compared with control group (P = 0.023). The addition of letrozole concurrently with neoadjuvant chemotherapy provides a higher clinical and pathologic response rates with acceptable toxicity compared with chemotherapy alone in postmenopausal women with locally advanced sensitive breast cancer.
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Affiliation(s)
- Mohammad Mohammadianpanah
- Department of Radiation Oncology, Cancer Research Center, Namazi Hospital, Shiraz University of Medical Sciences, 71936-11351 Shiraz, Iran.
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Hoover S, Bloom E, Patel S. Review of breast conservation therapy: then and now. ISRN ONCOLOGY 2011; 2011:617593. [PMID: 22229101 PMCID: PMC3200284 DOI: 10.5402/2011/617593] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/11/2011] [Indexed: 01/03/2023]
Abstract
Breast conservation therapy (BCT), which is the marriage of breast conserving surgery and radiation therapy to the breast, has revolutionized the treatment of breast cancer over the last few decades. Surgical direction had seen a heightened interest in the performance of cosmetically superior partial and segmental resections in breast conservation as well as increased demand by patients for breast preservation. The broadening of approaches to delivery of breast irradiation from whole breast to accelerated partial breast has allowed more patients to opt for breast conservation and allowed for what appears to be comparable measurable outcomes in emerging data. As well, the addition of state-of-the-art chemotherapeutic and hormonal therapies has allowed improved outcomes of patients from both local regional recurrence and overall survival standpoints. This paper will provide an overview of BCT and review some of the newest developments in optimizing this therapy for patients with breast cancer from a surgical-, medical-, and radiation-oncology standpoint.
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Affiliation(s)
- Susan Hoover
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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86
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Semiglazov V, Eiermann W, Zambetti M, Manikhas A, Bozhok A, Lluch A, Tjulandin S, Sabadell MD, Caballero A, Valagussa P, Baselga J, Gianni L. Surgery following neoadjuvant therapy in patients with HER2-positive locally advanced or inflammatory breast cancer participating in the NeOAdjuvant Herceptin (NOAH) study. Eur J Surg Oncol 2011; 37:856-63. [PMID: 21843921 DOI: 10.1016/j.ejso.2011.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/29/2011] [Accepted: 07/25/2011] [Indexed: 11/18/2022] Open
Abstract
AIM To describe surgical outcomes in patients with HER2-positive locally advanced (LABC) or inflammatory breast cancer (IBC) participating in the NeOAdjuvant Herceptin (NOAH) study (ISRCTN86043495). PATIENTS AND METHODS A total of 235 patients with HER2-positive disease were randomized to neoadjuvant trastuzumab plus chemotherapy (doxorubicin plus paclitaxel, followed by paclitaxel, followed by cyclophosphamide, methotrexate and fluorouracil) or neoadjuvant chemotherapy alone. Of these patients, 228 received their allocated treatment (115 received trastuzumab plus chemotherapy and 113 received chemotherapy alone) and were potentially eligible for surgery. Mastectomy was required for all patients with IBC and was recommended for all patients with LABC. However, breast-conserving therapy could be considered for patients with peripheral neoplasms measuring ≤ 4 cm in diameter at diagnosis, with a favorable ratio of tumor to breast volume, or at the patient's request if there had been a good response to treatment. RESULTS As previously reported, the addition of trastuzumab to neoadjuvant chemotherapy improved the overall, complete and pathological complete response to therapy and significantly improved event-free survival (the primary endpoint of the study). Trastuzumab also enabled more patients to have breast conserving surgery (BCS) (23% versus 13% respectively) without an apparent detrimental effect on local disease control (no patient treated with trastuzumab plus chemotherapy had experienced a local recurrence after BCS at the time of analysis). CONCLUSIONS Although this was not an aim of the trial, neoadjuvant trastuzumab given concurrently with chemotherapy enabled 23% of patients with HER2-positive LABC/IBC to avoid mastectomy (including a small number of patients with IBC).
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Affiliation(s)
- V Semiglazov
- NN Petrov Research Institute of Oncology, St. Petersburg Oncology, 68, Leningradskaya Str. Pesochny-2, St. Petersburg, Russian Federation, Russia.
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87
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Park SH, Moon WK, Cho N, Chang JM, Im SA, Park IA, Kang KW, Han W, Noh DY. Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer. Eur Radiol 2011; 22:18-25. [PMID: 21845462 DOI: 10.1007/s00330-011-2236-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/15/2011] [Accepted: 07/28/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the use of diffusion-weighted MR imaging (DWI) and (18)F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy. METHODS Thirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS After surgery, 7/34 patients (20.6%) were found to have pCR. A( z ) values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI. CONCLUSIONS DWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR.
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Affiliation(s)
- Sang Hee Park
- Department of Radiology, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, South Korea
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88
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[Role of locoregional radiation therapy in breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. The Institut Curie-Hôpital René-Huguenin experience]. Cancer Radiother 2011; 15:675-82. [PMID: 21831686 DOI: 10.1016/j.canrad.2011.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 04/04/2011] [Accepted: 04/13/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease and challenges the standard indications of adjuvant postmastectomy radiation therapy. We retrospectively evaluated the impact of postmastectomy radiation therapy in breast cancer patients with negative lymph nodes (pN0) after neoadjuvant chemotherapy. PATIENTS AND MATERIALS Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 134 patients had pN0 status after neoadjuvant chemotherapy and mastectomy. Demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The impact of postmastectomy radiation therapy on locoregional recurrence-free survival and overall survival was evaluated by multivariate analysis including known prognostic factors. RESULTS Among 134 eligible patients, 78 patients (58.2%) received postmastectomy radiation therapy, and 56 patients (41.8%) did not. With a median follow-up time of 91.4 months, the 10-year locoregional recurrence-free survival and overall survival rates were 96.2% and 77.2% with postmastectomy radiation therapy and 86.8% and 87.7% without radiation therapy, respectively (no significant difference). In multivariate analysis, there was a trend towards poorer overall survival among patients who did not have a pathologically complete primary tumour response after neoadjuvant chemotherapy (hazard ratio [HR], 6.65; 95% CI, 0.82-54.12; P=0.076). Postmastectomy radiation therapy had no effect on either locoregional recurrence-free survival (HR, 0.37; 95% CI, 0.09-1.61; P=0.18) or overall survival (HR, 2.06; 95% CI, 0.71-6; P=0.18). There was a trend towards poorer overall survival among patients who did not have pathologically complete in-breast tumour response after neoadjuvant chemotherapy (HR, 6.65; 95% CI, 0.82-54.12; P=0.076). CONCLUSIONS This retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence or death when postmastectomy radiation therapy was omitted in breast cancer patients with pN0 status after neoadjuvant chemotherapy and mastectomy. Whether the omission of postmastectomy radiation therapy is acceptable for these patients should be addressed prospectively.
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89
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Valachis A, Mauri D, Polyzos NP, Chlouverakis G, Mavroudis D, Georgoulias V. Trastuzumab combined to neoadjuvant chemotherapy in patients with HER2-positive breast cancer: a systematic review and meta-analysis. Breast 2011; 20:485-90. [PMID: 21784637 DOI: 10.1016/j.breast.2011.06.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/19/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To perform a meta-analysis in order to quantify the actual cumulative randomized evidence for the benefit and toxicity of trastuzumab combined with neoadjuvant chemotherapy in HER2-positive breast cancer. METHODS Potentially eligible trials were located through PubMed and Cochrane Library searches and abstracts of major international conferences. The endpoints that we assessed were pathologic complete response (pCR) rate, breast-conserving surgery (BCS) rate and toxicity. RESULTS Five trials were identified with 515 eligible patients. The probability to achieve pCR was higher for the trastuzumab plus chemotherapy arm (RR 1.85, 95% CI: 1.39-2.46; p-value < 0.001). No significant difference in terms of breast-conserving surgery between the two treatment arms was observed (OR: 0.98, 95% CI: 0.80-1.19, p-value = 0.82). Regarding toxicity, the addition of trastuzumab did not increase the incidence of neutropenia, neutropenic fever, and cardiac adverse events. CONCLUSION The addition of trastuzumab in HER2-positive breast cancer in the neoadjuvant setting improves the probability of achieving higher pCR with no additional toxicity. Based on the available evidence, the use of trastuzumab combined with neoadjuvant chemothetherapy in patients with HER2-positive breast cancer seems to offer substantial benefit in terms of pCR.
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Affiliation(s)
- Antonis Valachis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece.
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90
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Le Scodan R, Selz J, Stevens D, Bollet MA, de la Lande B, Daveau C, Lerebours F, Labib A, Bruant S. Radiotherapy for stage II and stage III breast cancer patients with negative lymph nodes after preoperative chemotherapy and mastectomy. Int J Radiat Oncol Biol Phys 2011; 82:e1-7. [PMID: 21377284 DOI: 10.1016/j.ijrobp.2010.12.054] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 12/22/2010] [Accepted: 12/31/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of postmastectomy radiotherapy (PMRT) in Stage II-III breast cancer patients with negative lymph nodes (pN0) after neoadjuvant chemotherapy (NAC). PATIENTS AND MATERIALS Of 1,054 breast cancer patients treated with NAC at our institution between 1990 and 2004, 134 had pN0 status after NAC and mastectomy. The demographic data, tumor characteristics, metastatic sites, and treatments were prospectively recorded. The effect of PMRT on locoregional recurrence-free survival and overall survival (OS) was evaluated by multivariate analysis, including known prognostic factors. RESULTS Of the 134 eligible patients, 78 (58.2%) received PMRT and 56 (41.8%) did not. At a median follow-up time of 91.4 months, the 5-year locoregional recurrence-free survival and OS rate was 96.2% and 88.3% with PMRT and 92.5% and 94.3% without PMRT, respectively (p = NS). The corresponding values at 10 years were 96.2% and 77.2% with PMRT and 86.8% and 87.7% without PMRT (p = NS). On multivariate analysis, PMRT had no effect on either locoregional recurrence-free survival (hazard ratio, 0.37; 95% confidence interval, 0.09-1.61; p = .18) or OS (hazard ratio, 2.06; 95% confidence interval, 0.71-6; p = .18). This remained true in the subgroups of patients with clinical Stage II or Stage III disease at diagnosis. A trend was seen toward poorer OS among patients who had not had a pathologic complete in-breast tumor response after NAC (hazard ratio, 6.65; 95% confidence interval, 0.82-54.12; p = .076). CONCLUSIONS The results from the present retrospective study showed no increase in the risk of distant metastasis, locoregional recurrence, or death when PMRT was omitted in breast cancer patients with pN0 status after NAC and mastectomy. Whether the omission of PMRT is acceptable for these patients should be addressed prospectively.
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Affiliation(s)
- Romuald Le Scodan
- Department of Radiation Oncology, Institut Curie-Hôpital René Huguenin, Saint-Cloud, France.
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91
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Park SH, Moon WK, Cho N, Song IC, Chang JM, Park IA, Han W, Noh DY. Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. Radiology 2010; 257:56-63. [PMID: 20851939 DOI: 10.1148/radiol.10092021] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the potential of diffusion-weighted (DW) magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map in the prediction of response to neoadjuvant chemotherapy in patients with breast cancer. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, which waived the informed consent requirement. Fifty-three consecutive women (mean age, 43.7 years; median age, 42.0 years; age range, 24-65 years) with 53 invasive breast cancers (mean diameter, 5.0 cm; median diameter, 4.2 cm; diameter range, 2.0-13.3 cm) who had undergone chemotherapy were included. Both DW MR imaging (b values, 0 and 750 sec/mm(2)) and dynamic contrast material-enhanced (DCE) MR imaging were performed at 1.5 T before and after chemotherapy prior to surgery. Mean time from initiation of chemotherapy to posttreatment ADC measurement was 54 days (range, 48-62 days). Average ADC for three regions of interest per tumor on ADC maps was calculated. Patients with a reduction in tumor diameter of at least 30% after chemotherapy at DCE MR imaging were defined as responders. Pretreatment ADCs and percentage increases in ADC after chemotherapy in responders and nonresponders were compared. The best pretreatment ADC cutoff with which to differentiate between responders and nonresponders was calculated with receiver operating characteristic curve analysis. RESULTS After chemotherapy, 36 (68%) patients were classified as responders, and 17 (32%) were classified as nonresponders. Pretreatment mean ADC ([1.036 ± 0.015] × 10(-3) mm(2)/sec [standard error]) of responders was significantly lower than that of nonresponders ([1.299 ± 0.079] × 10(-3) mm(2)/sec) (P = .004). Furthermore, mean percentage ADC increase of responders (47.9% ± 4.8) was higher than that of nonresponders (18.1% ± 4.5) (P < .001). The best pretreatment ADC cutoff with which to differentiate between responders and nonresponders was 1.17 × 10(-3) mm(2)/sec, which yielded a sensitivity of 94% (95% confidence interval [CI]: 81%, 99%) and a specificity of 71% (95% CI: 44%, 90%). CONCLUSION Patients with breast cancer and a low pretreatment ADC tended to respond better to chemotherapy. Prediction of response to neoadjuvant chemotherapy with DW MR imaging might help physicians individualize treatments and avoid ineffective chemotherapy.
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Affiliation(s)
- Sang Hee Park
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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92
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Inflammatory breast carcinoma and locally advanced breast carcinoma: characterisation with MR imaging. Radiol Med 2010; 116:71-83. [DOI: 10.1007/s11547-010-0590-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 02/09/2010] [Indexed: 11/26/2022]
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93
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Daveau C, Stevens D, Brain E, Berges O, Villette S, Moisson P, Gardner M, De la Lande B, Lasry S, Labib A, Le Scodan R. Is Regional Lymph Node Irradiation Necessary in Stage II to III Breast Cancer Patients With Negative Pathologic Node Status After Neoadjuvant Chemotherapy? Int J Radiat Oncol Biol Phys 2010; 78:337-42. [DOI: 10.1016/j.ijrobp.2009.08.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 11/25/2022]
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Polgár C, Csejtei A, Gábor G, Landherr L, Mangel L, Mayer A, Németh G, Fodor J. [Principles of radiotherapy (in breast cancer)]. Magy Onkol 2010; 54:257-65. [PMID: 20870602 DOI: 10.1556/monkol.54.2010.3.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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95
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Papademetriou K, Ardavanis A, Kountourakis P. Neoadjuvant therapy for locally advanced breast cancer: Focus on chemotherapy and biological targeted treatments' armamentarium. J Thorac Dis 2010; 2:160-70. [PMID: 22263038 PMCID: PMC3256458 DOI: 10.3978/j.issn.2072-1439.2010.02.03.8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/07/2010] [Indexed: 01/20/2023]
Abstract
Despite progress achieved in diagnosis and therapy in recent years, locally advanced breast cancer (LABC) remains a major clinical issue. Biological characteristics and clinical behavior varies widely, ranging from indolent to locally aggressive or generalized disease. In depth knowledge of biology of cancer progression and cancer could lead to the identification of tumor characteristics associated with outcome. Neoadjuvant chemotherapy (NCT) integrated into a multimodality program is nowadays the established treatment in LABC. Although our efforts in this research task are ongoing, of special clinical interest is the integration of anti-HER2 and other biological therapies, as anti-angiogenesis targeted treatments, that may further improve the long term control of LABC. Clinical management of LABC could be modified based on molecular biology and an approach tailored to each patient will optimize therapy.
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Affiliation(s)
| | - Alexandros Ardavanis
- First Department of Medical Oncology, Saint Savas Anticancer Hospital, Athens, Hellas
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96
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Mallmann MR, Staratschek-Jox A, Rudlowski C, Braun M, Gaarz A, Wolfgarten M, Kuhn W, Schultze JL. Prediction and prognosis: impact of gene expression profiling in personalized treatment of breast cancer patients. EPMA J 2010. [PMID: 23199086 PMCID: PMC3405335 DOI: 10.1007/s13167-010-0044-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Breast cancer is a complex disease, whose heterogeneity is increasingly recognized. Despite considerable improvement in breast cancer treatment and survival, a significant proportion of patients seems to be over- or undertreated. To date, single clinicopathological parameters show limited success in predicting the likelihood of survival or response to endocrine therapy and chemotherapy. Consequently, new gene expression based prognostic and predictive tests are emerging that promise an improvement in predicting survival and therapy response. Initial evidence has emerged that this leads to allocation of fewer patients into high-risk groups allowing a reduction of chemotherapy treatment. Moreover, pattern-based approaches have also been developed to predict response to endocrine therapy or particular chemotherapy regimens. Irrespective of current pitfalls such as lack of validation and standardization, these pattern-based biomarkers will prove useful for clinical decision making in the near future, especially if more patients get access to this form of personalized medicine.
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Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics & Gynecology, Center for Integrated Oncology, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany ; LIMES (Life and Medical Sciences Bonn) Institute, Genomics and Immunoregulation, University Bonn, Carl-Troll-Strasse 31, 53115 Bonn, Germany
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97
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Daveau C, Stevens D, Labib A, Berges O, Moisson P, De la Lande B, Le Scodan R. [Role of lymph node irradiation in breast cancer patients with negative pathologic node status after neoadjuvant chemotherapy: the René-Huguenin Cancer Center experience]. Cancer Radiother 2010; 14:711-7. [PMID: 20674445 DOI: 10.1016/j.canrad.2010.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/08/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation in breast cancer patients with pathological N0 status (pN0) after neoadjuvant chemotherapy and breast-conserving surgery. PATIENTS AND MATERIALS Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 248 patients with clinical N0 or N1-N2 lymph node status at diagnosis had pN0 status after neoadjuvant chemotherapy and breast-conserving surgery. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival, disease-free survival and overall survival. RESULTS All 248 patients received breast irradiation, and 158 patients (63.7%) also received lymph node irradiation. With a median follow-up of 88 months, the 5-year locoregional recurrence-free survival and overall survival rates were respectively 89.4% and 88.7% with lymph node irradiation and 86.2% and 92% without lymph node irradiation (no significant difference). Survival was poorer among patients who did not have a pathological complete primary tumor response (pCR) (hazards ratio [HR]=3.05; 95% CI, 1.17 to 7.99) and in patients with N1-N2 clinical status at diagnosis ([HR]=2.24; 95% CI, 1.15 to 4.36). Lymph node irradiation did not significantly affect survival. CONCLUSIONS Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among breast cancer patients with pN0 status after neoadjuvant chemotherapy. These results need to be confirmed in a prospective study.
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Affiliation(s)
- C Daveau
- Département de radiothérapie, centre René-Huguenin, hôpital René Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
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98
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Specht JM, Kurland BF, Montgomery SK, Dunnwald LK, Doot RK, Gralow JR, Ellis GK, Linden HM, Livingston RB, Allison KH, Schubert EK, Mankoff DA. Tumor metabolism and blood flow as assessed by positron emission tomography varies by tumor subtype in locally advanced breast cancer. Clin Cancer Res 2010; 16:2803-10. [PMID: 20460489 DOI: 10.1158/1078-0432.ccr-10-0026] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Dynamic positron emission tomography (PET) imaging can identify patterns of breast cancer metabolism and perfusion in patients receiving neoadjuvant chemotherapy (NC) that are predictive of response. This analysis examines tumor metabolism and perfusion by tumor subtype. EXPERIMENTAL DESIGN Tumor subtype was defined by immunohistochemistry in 71 patients with locally advanced breast cancer undergoing NC. Subtype was defined as luminal [estrogen receptor (ER)/progesterone receptor (PR) positive], triple negative [TN; ER/PR negative, human epidermal growth factor receptor 2 (HER2) negative], and HER2 (ER/PR negative, HER2 overexpressing). Metabolic rate (MRFDG) and blood flow (BF) were calculated from PET imaging before NC. Pathologic complete response (pCR) to NC was classified as pCR versus other. RESULTS Twenty-five (35%) of 71 patients had TN tumors; 6 (8%) were HER2 and 40 (56%) were luminal. MRFDG for TN tumors was on average 67% greater than for luminal tumors (95% confidence interval, 9-156%) and average MRFDG/BF ratio was 53% greater in TN compared with luminal tumors (95% confidence interval, 9-114%; P<0.05 for both). Average BF levels did not differ by subtype (P=0.73). Most luminal tumors showed relatively low MRFDG and BF (and did not achieve pCR); high MRFDG was generally matched with high BF in luminal tumors and predicted pCR. This was not true in TN tumors. CONCLUSION The relationship between breast tumor metabolism and perfusion differed by subtype. The high MRFDG/BF ratio that predicts poor response to NC was more common in TN tumors. Metabolism and perfusion measures may identify subsets of tumors susceptible and resistant to NC and may help direct targeted therapy.
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Affiliation(s)
- Jennifer M Specht
- Medical Oncology and Nuclear Medicine, Department of Medicine, University of Washington, Seattle, Washington 98109, USA.
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99
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Overmoyer BA. Inflammatory breast cancer: novel preoperative therapies. Clin Breast Cancer 2010; 10:27-32. [PMID: 20133255 DOI: 10.3816/cbc.2010.n.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The treatment of inflammatory breast cancer (IBC) has been hampered by the diagnostic rarity of the disease and its consequent inclusion in clinical trials of preoperative treatment for the more indolent locally advanced breast cancer (LABC). Patients with IBC have a 2-fold greater probability of dying of their disease compared with patients diagnosed with LABC. The aggressive clinical portrait of IBC supports the recent investigative focus on determining molecular changes specific to IBC and developing novel systemic therapies that will favorably affect its poor disease prognosis. A significant amount of laboratory research has been involved in defining a specific "inflammatory signature" for IBC, denoting molecular changes consistently found in IBC. This work has involved human IBC tissue and cell lines and has demonstrated overexpression of several molecules governing metastatic dissemination, such as overexpression of E-cadherin concurrent with a dysfunctional mucin 1. An increased prevalence of mutant TP53, overexpression of RhoC, and vascular endothelial growth factor-A has been found to contribute to the dominant influence of angiogenesis in this disease. A greater understanding of the molecular mechanisms governing the pathophysiology of IBC has led to the development and clinical application of novel targeting agents for preoperative therapy. This study reviews the advances in molecular understanding of IBC and focuses on the efficacy of therapies that target the epidermal growth factor pathway and angiogenesis as well as early investigational therapies involving RhoC and TP53.
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100
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Frasci G, D’Aiuto G, Comella P, D’Aiuto M, Di Bonito M, Ruffolo P, Iodice G, Petrillo A, Lastoria S, Oliviero P, Capasso I, Montella M, Siani C, Santangelo M, Vizioli L, Comella G. Preoperative weekly cisplatin, epirubicin, and paclitaxel (PET) improves prognosis in locally advanced breast cancer patients: an update of the Southern Italy Cooperative Oncology Group (SICOG) randomised trial 9908. Ann Oncol 2010; 21:707-716. [DOI: 10.1093/annonc/mdp356] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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